Abstract
Developing robotic tools that introduce substantial changes in the surgical workflow is challenging because quantitative requirements are missing. Experiments on cadavers can provide valuable information to derive workspace requirements, tool size, and surgical workflow. This work aimed to quantify the volume inside the knee joint available for manipulation of minimally invasive robotic surgical tools. In particular, we aim to develop a novel procedure for minimally invasive unicompartmental knee arthroplasty (UKA) using a robotic laser-cutting tool. Contrast solution was injected into nine cadaveric knees and computed tomography scans were performed to evaluate the tool manipulation volume inside the knee joints. The volume and distribution of the contrast solution inside the knee joints were analyzed with respect to the femur, tibia, and the anatomical locations that need to be reached by a laser-cutting tool to perform bone resection for a standard UKA implant. Quantitative information was determined about the tool manipulation volume inside these nine knee joints and its distribution around the cutting lines required for a standard implant. Based on the volume distribution, we could suggest a possible workflow for minimally invasive UKA, which provides a large manipulation volume, and deducted that for the proposed workflow, an instrument with a thickness of 5-8mm should be feasible. We present quantitative information on the three-dimensional distribution of the maximally available volume inside the knee joint. Such quantitative information lays the basis for developing surgical tools that introduce substantial changes in the surgical workflow.
Highlights
K NEE arthroplasty is a surgical intervention for the treatment of advanced osteoarthritis of the knee
We analyzed the thickness of the available manipulation volume inside the knee joint above the femur and tibia surface by injecting contrast solution and performing CT scans
To extract quantitative information on the available manipulation volume for unicompartmental knee arthroplasty (UKA), we examined the available manipulation volume at the locations relevant for this procedure, i.e., the cutting lines that need to be reached by a surgical instrument to perform bone cutting with a laser for placing a standard medial UKA implant (Fig. 8)
Summary
K NEE arthroplasty is a surgical intervention for the treatment of advanced osteoarthritis of the knee. In this procedure, the damaged bone and cartilage are replaced with implants. Poor implant positioning in UKA may lead to early implant wear, poor functional results, and a higher revision rate [10], [11]. Performing UKA with a smaller incision (less invasively) may reduce visible anatomical landmarks compared to conventional UKA. This would make the intraoperative orientation and proper positioning of the components even more difficult [12]
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